Pennsylvania taxpayers spending millions on braces

Spending doubled in 4 years

Any parent can tell you braces are expensive, costing $3,000 to $5,000. But many parents whose kids are on Medicaid do not have to pay a dime for braces. The cost is picked up by taxpayers. And WTAE Channel 4 Action News found taxpayer spending on braces doubled in Pennsylvania in just four years.

The money comes from Medicaid, the program that insures the poor. Some orthodontists in Western Pennsylvania are raking in millions from Medicaid.

Leanna Sleith, of Monongahela, has had braces for two years. Her sister also had braces and her brother is about to get them. But her mother, Sherri Story, is not worried about the cost: “Zero. They've covered everything.”

Medicaid covers her, but it does not cover Mary Beth Myers, of Bethel Park. And like most people, her private insurance won't pay for braces. “Three kids, three sets of braces, that's a pretty scary bill,” Myers said.

But millions of taxpayer dollars are paying for kids on Medicaid to have braces. Records obtained by Channel 4 Action News show Medicaid spending for orthodontics in Pennsylvania skyrocketed from $15.6 million in 2008 to $29 million in 2011. The number of children on Medicaid getting orthodontic treatment went from 19,981 to 33,337.

The amount paid has actually doubled. Why such a huge increase? "Well, the main increase may have been seen in the HealthChoices area," said Dr. Paul Westerberg, a dentist at the Department of Public Welfare who's in charge of the Medicaid dental program.

He's talking about the Medicaid health maintenance organizations, which operate independently of state government even though they get taxpayer money. "We're not in a position to tell them how to spend their money," Westerberg said.

Van Osdol: “But it's your money, right?”Westerberg: “No, it's not my money. It is the taxpayer's money. But how they choose to spend it on their particular membership to meet their needs is -- they are at arm's length with us in their contracts.”

The state gives the HMOs a set amount of money for Medicaid. Then the HMOs decide how much to spend on orthodontics and how much on other procedures. All that money spent on braces could be going to other medical needs. Or, it could be returned to the taxpayers.

Privately, some orthodontists grumble that Medicaid pays them less than private patients. Still, records reveal there are orthodontists in Western Pennsylvania who have made millions off of Medicaid.

One who practices locally was paid $6.4 million by Medicaid over four years. Another got more than $5 million. None of the orthodontists who were contacted by Channel 4 Action News responded to requests for an interview.

Medicaid rules say orthodontic treatments must be medically necessary -- not cosmetic. But one teen told us he had no medical issues.

“I wanted my teeth to be straight. I just hated my teeth being crooked,” said Tyshon Culverson of East Liberty. We also asked his mother if Culverson had any medical need for braces. She said he did not.

Medicaid's top dentist says the line that separates medically necessary from cosmetic is not always clear.

Van Osdol: “Does it concern you that parents might be getting treatment that's not medically necessary under the rules?”Westerberg: “Certainly we do not condone abuse of the system.”

But a state government watchdog said WTAE's findings show that the system needs a shakeup. “These are the types of things that have turned welfare from a safety net into a hammock and it's not serving the taxpayers or the poor very well,” said Matthew Brouillette, of the Commonwealth Foundation.